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Subject

Company Name

Contact name

Registered business address

Liberty department engaging your services

Main activities your company will be undertaking regularly for Liberty

select all that apply

Details of your query

Please enter the details of your query. Use the "Attachments" section to upload screenshots and photographs.

Do you have a Risk Assessment and Method Statement (RAMS) for the proposed works?

Please attach via the "Attachments" option below

Please explain why RAMS are not available

(e.g, Project Scope not yet defined)

How many accidents has your company had in the past three years?

Has your company had any RIDDOR reportable incidents in the past three years?

Provide details of any Improvement / Prohibition Notices or Prosecutions (including those Pending) that have occurred in the past three years

Public Liability Insurance Certificate attached

Please attach via the "Attachments" option below

Employers Liability Insurance Certificate attached

Please attach via the "Attachments" option below

Does your company have an Environmental Policy

Please attach via the "Attachments" option below

Could your work introduce the risk of disturbing asbestos?

If you are disturbing the fabric of the building, e.g. drilling, fixing or installing items, it is possible you could disturb asbestos

Have all your operatives received Asbestos Awareness Training?

Have you viewed the Liberty Asbestos Register?

you can request asbestos information by emailing healthandsafety@libertylondon.com

Will you be carrying out Hot Works?

Have you completed the Hot Works section on the Access Form and understand the Permit arrangements?

Please attach copies of relevant professional qualifications held by indiviuals (e.g. Gas Safe Registration) who will be working on Liberty assets

Please attach via the "Attachments" option below

If relevant - please attach copies of any relevant licences and/or accreditation(s) to professional bodies(optional)

Please attach via the "Attachments" option below

Please provide two references for your company from clients you have carried out work for

Please attach via the "Attachments" option below

Do you have ISO 45001/CHAS or other SSIP Certification.

Please attach via the "Attachments" option below

Does the company have a written Health and Safety Policy that includes responsibilities and arrangements?

if 'yes' please attach via the "Attachments" option below

Please give details of your source of competent advice on health & safety (Name/Company, Qualifications)

Does the company hire Subcontractors or Freelancers to carry out work for Liberty?

How will you ensure that Subcontractors' / Freelancers' work is carried out safely?

Facilities department

What type of issue are you reporting?

Attachments(optional)

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